PURCHASE REQUISITION
** Please send this completed form with quotes, agreements, & other supporting documents to BSF, Rm P-63.
For questions or assistance, please call x7089.
DATE
GGU REQUESTOR EXT. # DEPARTMENT
GGU CONTACT. If different from above. EXT. # DEPARTMENT
SUGGESTED VENDOR INFORMATION
If none, please leave blank.
COMPANY NAME CONTACT NAME
STREET ADDRESS TELEPHONE #
CITY, STATE ZIP CODE FAX #
WEB ADDRESS EMAIL
BUDGET ACCOUNT QTY $/UNIT DESCRIPTION TOTAL
SIGNATURE OF BUDGET AUTHORITY. Approving the above info/request. PRINT NAME OF BUDGET AUTHORITY DATE
SIGNATURE OF TECH AUTHORITY (ETS dept.). For tech purchases only. PRINT NAME OF TECH AUTHORITY DATE
TO BE FILLED OUT BY PURCHASING DEPARTMENT:
PO# ADDENDUM/REVISION # 2-WAY / 3-WAY PO ORDERED DATE
